Adjuvant Radiotherapy and Survival for Patients With Node-Positive Head and Neck Cancer: An Analysis by Primary Site and Nodal Stage
Received 4 July 2007; received in revised form 28 September 2007; accepted 28 September 2007. published online 03 January 2008.
Purpose
Adjuvant radiotherapy (RT) is frequently recommended for node-positive head and neck squamous cell carcinoma (HNSCC) treated with primary surgery. The impact of RT on survival for various subgroups of node-positive HNSCC has not been clearly demonstrated.
Methods and Materials
Within the Surveillance, Epidemiology, and End Results (SEER) Database, we identified 5297 patients with node-positive (N1 to N3) HNSCC treated with definitive surgery with or without adjuvant RT between 1988 and 2001. The median follow-up was 4.4 years.
Results
Adjuvant RT significantly improved 5-year overall survival (46.3%: 95% confidence interval [CI], 44.7–48.0% for surgery + RT, vs. 35.2%: 95% CI, 32.0–38.5% for surgery alone, p < 0.001) and cancer-specific survival (54.8%: 95% CI, 53.2–56.4% for surgery + RT, vs. 46.2% for surgery alone 95% CI, 42.4–50.0%, p < 0.05). Use of adjuvant RT remained a significant predictor of survival on multivariable analysis (hazard ratio [HR], 0.75; 95% CI, 0.68–0.83; p < 0.001). Subset analyses demonstrated that adjuvant RT was associated with significantly improved survival for N1 (HR, 0.78; 95% CI; 0.67–0.90; p = 0.001), N2a (HR, 0.82; 95% CI, 0.67–0.99, p = 0.048) and N2b to N3 nodal disease (HR, 0.62; 95% CI, 0.51–0.75; p < 0.001). Adjuvant RT increased overall survival for node-positive patients with oropharynx (HR, 0.72; 95% CI, 0.57–0.90; p = 0.004), hypopharynx (HR, 0.66; 95% CI, 0.49 to 0.88; p = 0.004), larynx (HR, 0.66; 95% CI, 0.52–0.84; p = 0.001), and oral cavity (HR, 0.84; 95% CI, 0.73–0.98; p = 0.025) primary tumors.
Conclusions
In a large population-based analysis, adjuvant RT significantly improves overall survival for patients with node-positive HNSCC. All nodal stages, including N1, appear to benefit from the addition of RT to definitive surgery.
∗Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY
†Department of Otolaryngology and Head and Neck Surgery, Mount Sinai School of Medicine, New York, NY
Reprint requests to: Johnny Kao, M.D., Department of Radiation Oncology, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1236, New York, NY 10029. Tel: (212) 241-7503; Fax: (212) 410-7194
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